Department of Health and Social Care

Mental Health Services

Baroness Gale: To ask Her Majesty's Government what assessment they have made of the recommendations of the report by the National Neurosciences Advisory Group on their June 2019 Mental Health and Neurosciences Leaders Away Day, published on 24 July.

Lord Bethell: While the Department has not made a specific assessment, NHS England and NHS Improvement work closely with the National Neurosciences Advisory Group (NNAG) which is a collaborative leadership group for neurosciences in England. The group is co-chaired by Professor Adrian Williams, who is also Chair of the Neurosciences Clinical Reference Group, at NHS England and NHS Improvement. The report published on 24 July, stems from the June 2019 Mental Health and Neurosciences Leaders Away Day, which was attended by senior NHS England and NHS Improvement officials. The NNAG will begin consulting NHS England and NHS Improvement on the drafting of new clinical pathways across neurology shortly and aims to publish these on the Neurological Alliance website by the end of 2020. Furthermore, work is ongoing in other areas of NHS England and NHS Improvement to improve integration of care for neurology patients. For example, the training curriculum for Improving Access to Psychological Therapies Long-Term Conditions programme is being updated and, once completed, mental health services will be able to pursue integration with neurological pathways

Contact Tracing: Contracts for Services

Lord Scriven: To ask Her Majesty's Government which companies they approached to compete for the contract to review the NHS Test and Trace system; and how they approached such companies.

Lord Bethell: The contract with McKinsey commenced on 18 May 2020. McKinsey were approached via the Crown Commercial service Management Consultancy Framework 2. They were selected following the guidance on the framework due to their experience on working on similar requirements, their ability to deliver at pace and their ability to deliver at extremely short notice given the urgency of the COVID-19 situation.

Coronavirus: Travel

Lord Jones of Cheltenham: To ask Her Majesty's Government how those entering England who are required to self-isolateare permitted totravel from their port of entry to their places of residence; and what measures are being taken to ensure that they do not infect others whilst travelling.

Lord Bethell: International arrivals to England who are required to self-isolate must travel directly from their port of entry to the location where they intend to self-isolate. Information about how passengers can travel safely is available online at GOV.UK. Passengers should only use public transport if they have no other option and must wear face coverings when travelling on public transport, unless exempt from the requirement to wear a face covering on public transport. Where a passenger is assessed as symptomatic, they will be advised not to use public transport. If necessary, transport will be arranged for them.

Coronavirus: Disease Control

Lord Wigley: To ask Her Majesty's Government which towns, counties or communities in England had an 'R' rate for COVID-19 reinfection in excess of 1.0 during June; what specific steps were taken in each of these areas to reduce the figure to below 1.0; and by what date this was achieved in each case.

Lord Bethell: The Government Office for Science currently publishes the latest estimate of the reproduction number (R) for the United Kingdom and NHS England regions on a weekly basis. We do not estimate R for geographies smaller than regional level.R is an average value that can vary in different parts of the country, communities, and subsections of the population. It cannot be measured directly so there is always uncertainty around its exact value. This is problematic when calculating R using small numbers of cases, either due to lower infection rates or smaller geographical areas. This uncertainty may be due to variability in the underlying data, leading to a wider range for R and more frequent changes in the estimates. R is not the only important measure of the epidemic and should be considered alongside other measures such as the number of new cases.For this reason, the Scientific Advisory Group for Emergency’s view is that estimates of R for geographies smaller than regional level are less reliable. It is more appropriate to identify local hotspots through, for example, monitoring numbers of cases, hospitalisations, and deaths.

Coronavirus: Screening

Lord Oates: To ask Her Majesty's Government whether a COVID-19 test comprising of a swab of the back of the throat and the nose, (1) taken at the same time, (2) at the same testing venue, and (3) from the same person, is counted as (a) one test, or (b) two tests. [T]

Lord Bethell: For the purposes of diagnosing COVID-19, we are using Polymerase Chain Reaction tests that involve a nasopharyngeal swab sample taken from the back of the nose and throat, searching for virus DNA in the sample.Tests that do not reach far enough back or swab just the nose or throat alone are likely to be less effective as there is a lower likelihood of collecting the virus in the sample material. For this reason, we recommend both clinician-administered and self-administered tests available for home testing swab both the nose and throat. This will count as a single test.

Ventilators

Baroness Campbell of Surbiton: To ask Her Majesty's Government what assessment they have made of reports that home ventilation users in England have been refused adequate supplies of anti-bacteria and anti-viral filters for use in their home ventilators due to shortages in the NHS; and whether they have commissioned an Equality Impact Assessment so that the likely impact of this on disabled people can be determined.

Baroness Campbell of Surbiton: To ask Her Majesty's Government whatplans they have to ensure that home ventilation users in England have access to adequate supplies of anti-bacteria and anti-viral filters for use in their home ventilators from the NHS.

Lord Bethell: We understand how challenging this period has been for people who rely on ventilation and we are doing everything we can to support patients, led by clinical advice.COVID-19 has caused a significant increase in demand for clinical consumables and has disrupted international supply chains, making it more difficult to source products, including a small number of products for ventilators.The Department, working closely with NHS England and NHS Improvement, has put in place a range of measures to address these challenges, including making it easier for clinicians to report shortages and identifying opportunities to open up new supply options and using additional brands.We have received assurances from the key supplier of filters for ventilators that supply chains are now restored and they have resumed processing orders and working through the backlog. Currently none of the National Health Service trusts who supply patients in the community with these consumables are reporting critically low stock levels. However, we will of course keep this under very close review and, if necessary, work with suppliers to prioritise deliveries to areas with the greatest clinical need.NHS England and NHS Improvement are also working closely with clinicians, trusts and suppliers to prepare for winter and ensure there are sufficient stocks of these consumables to meet the need of all patients who require home ventilation as well as for any future spike in COVID-19 cases going forward.

Spain: Coronavirus

Lord Blencathra: To ask Her Majesty's Government what assessment they have made of reports that the majority of those returning from Spain do not intend to adhere to quarantine when they return; and what steps they intend to take to ensure that such people do adhere to quarantine rules.

Lord Bethell: We will take enforcement action against people who endanger the safety of others in breaching the self-isolation requirement for those arriving into England from non-exempt countries. Those who fail to comply with the mandatory conditions could face enforcement action. A breach of self-isolation would be punishable with a £1,000 fixed penalty notice in England or potential prosecution and unlimited fine. Self-isolation is enforced in communities by local police. Border force will undertake spot checks at the border and may refuse entry where the individual is neither a British citizen nor a non-British citizen resident in the United Kingdom and refuses to comply with these regulations. Failure to complete the contact locator form is punishable by a £100 fixed penalty notice.

Coronavirus: Disease Control

Baroness Ritchie of Downpatrick: To ask Her Majesty's Government whatdiscussions they have had, and with whom, aboutpreparation for anyfurther local lockdowns in response to the COVID-19 pandemic.

Lord Bethell: Across the country local authorities have done exceptional work to prepare their communities for COVID-19 outbreaks, protecting the most vulnerable and saving lives.As of 1 July, all 152 upper tier local authorities have created and shared their outbreak plans. Their plans focus on identifying and containing potential outbreaks in places such as workplaces, ensuring testing capacity is deployed effectively and helping the most vulnerable in self isolation.Councils were given £300 million in new dedicated funding to support this and have published further guidance on containing local outbreaks. The package recognises the additional costs and pressures on finances councils are facing as a result of the current crisis.The Government will continue to work closely with councils as the pandemic progresses.

NHS: Ventilators

Baroness Hayter of Kentish Town: To ask Her Majesty's Government how many mechanical ventilators are currently available to the NHS.

Baroness Hayter of Kentish Town: To ask Her Majesty's Government how many ventilators have been made available as a result of the Ventilator Challenge; and how many of those are currently in use.

Lord Bethell: At the start of the crisis in March the National Health Service across the United Kingdom had access to over 9,000 mechanical ventilators including 7,484 in England and 1,655 in the devolved administrations.Today, there are around 30,400 (current total 30,382) mechanical ventilators available to patients across the UK. The additional stock comprises 6,089 from established suppliers (118 manufactured in UK, the rest overseas) and 15,154 from new suppliers, through the Prime Minister’s ventilator challenge, mostly made in the UK.

Coronavirus: Travel

Lord Jones of Cheltenham: To ask Her Majesty's Government what COVID-19 testing iscarried out(1) at airports, and(2) at other points of entry into England.

Lord Bethell: International arrivals are required to supply their contact and accommodation information, and self-isolate in their accommodation for 14 days, unless they are arriving from an exempt country or covered by another exemption.National Health Service testing capacity is currently reserved for testing symptomatic people in the United Kingdom, with any spare capacity being used to where most clinically effective.The Government continues to consider a range of options to manage the risk of imported cases.

Coronavirus: Contact Tracing

Lord Bassam of Brighton: To ask Her Majesty's Government what comparative analysis they have undertaken of the success rates of COVID-19 contract tracing applications in other countries against that of the NHS Test and Trace scheme; and what plans they have to publish any such analysis.

Lord Bethell: A large number of other countries have launched apps and we have been in close contact with a number of these countries to share what we are learning. We have been working in collaboration with other app development teams across the world - including Ireland, Germany, Italy, Denmark, and New Zealand to exchange ideas. This includes sharing information on download rates and other information on how apps are being used as tools in the response to COVID-19.Like the United Kingdom, many countries are working on solutions that best support local systems while taking into account cultural and societal differences, and ultimately each country will have to adapt its approach to digital contact tracing to its own local context, including integration with its own test and trace programme.The success of a contact tracing app will depend on a multitude of factors, including public trust, the reproduction number (R) of the country, and societal context.

Contact Tracing: Data Protection

Lord Hunt of Kings Heath: To ask Her Majesty's Government what assessment they have made of the consistency of the answer on Data Protection Impact Assessments by the Secretary of State for Health on 20 July (HC Deb, col 1865) with section 251(7) of the National Health Service Act 2006.

Lord Bethell: We are compliant with the requirements of data protection legislation, ensuring data is used in a safe, secure and legal way. As such, we are completing all necessary Data Protection Impact Assessments in order to meet our obligations to do so, under the General Data Protection Regulation as implemented by the Data Protection Act 2018.

McKinsey and Company: Contact Tracing

Lord Scriven: To ask Her Majesty's Government what plans they have to publish a breakdown of the elements of the NHS Test and Trace system that McKinsey have been contracted to review.

Lord Bethell: The objectives/elements of this work are to define options for the vision, purpose and narrative; end-to-end journeys; organisation, roles and talent; interfaces and governance; and integrated roadmap all for the medium-term entity.

Preventive Medicine: Screening

Lord Empey: To ask Her Majesty's Government whether they plan to make financial resources available to assist in the growth of the UK health care testing industry.

Lord Bethell: NHS Test and Trace is currently planning to spend in the region of £75 million which will be directed towards the evaluation and adoption of new technologies to ensure that we use the fullest range of innovations to support our testing policy as it develops.Alongside this, the Government is working with the life sciences sector on proposals to strengthen the United Kingdom diagnostics industry and how the National Health Service market can make better use of innovative diagnostics.

Palantir: Contracts

Lord Strasburger: To ask Her Majesty's Government why Palantir’s contract with NHS England for the NHS COVID-19 Data Store allows that company to process sensitive personal data such as “political affiliations, religious or similar beliefs”.

Lord Bethell: Data in the NHS COVID-19 Data Store is de-identified by National Health Service staff before the data is analysed on Palantir's platform.As such, no identifiable data is being accessed by anyone other than the NHS.Data is only processed under instruction by NHS England and the companies involved cannot use the data for their own purposes.

Social Distancing: Computer Software

Lord Strasburger: To ask Her Majesty's Government to provide a list of the data collected for the NHS COVID-19 Data Store which is to measure compliance with social distancing, including the “intelligence”referred to by the Chancellor of the Duchy of Lancaster in his evidence to the Public Administration and Constitutional Affairs Committee on 29 April.

Lord Bethell: The COVID-19 Data Store Reference Library describes the datasets being used in the NHS COVID-19 Data Store, and the sources of those datasets.As more data is added to support the COVID-19 response the list will be updated.

Drugs and Medical Equipment: Procurement

Baroness Masham of Ilton: To ask Her Majesty's Government what steps they are taking to rebuild UK stockpiles of medicines and other health products used during the COVID-19 pandemic, and which were initially procured as part of their preparations for the end of the transition period for the UK’s departure from the EU.

Lord Bethell: The stockpiles that were used during the initial COVID-19 response were either ‘business as usual’ stockpiles, stockpiles procured in preparation for a potential ‘no-deal’ exit from the European Union, or stockpiles procured specifically for pandemic response.The Department has been procuring medicines and medical products in preparation for future cases of COVID-19 and as part of its preparations for the end of the transition period.

Care Homes: Coronavirus

Lord Alton of Liverpool: To ask Her Majesty's Government what assessment they have made of the comments by the UN Human Rights Commissioner about the operation of care homes during the COVID-19 pandemic; what assessment they have made of reports of care home staff (1) abandoning care homes, (2) leaving residents to die alone, (3) failing to make adequate preparations, and (4) failing to provide guidance and personal protection equipment; what assessment they have made, in assessing such reports, of the human rights of patients and staff in care homes; and what plans they have to support the call for a UN convention on the rights of the elderly.

Lord Bethell: The Government is aware of comments on care homes during the COVID-19 pandemic made by the UN Special Rapporteurs and the UN Independent Expert.The Care Quality Commission (CQC) is not aware of any specific reports of care home staff abandoning care homes or specific cases where residents have been left to die alone. The CQC (Registration) Regulations 2009 set out requirements for incidents and events that must be reported to the CQC, which covers deaths and serious injuries, abuse, incidents reported to the police and events that prevent a service from being carried on safely and in a way that meets legal requirements.Before the COVID-19 outbreak, each care provider was responsible for sourcing their own personal protective equipment (PPE) from wholesalers and distribution centres. While this was effective and appropriate before the outbreak, it became clear that this fragmented system would be slow to get PPE where it needed to be. To address this, the United Kingdom Government stepped in to support the supply and distribution of PPE to the care sector. We have focused on ensuring that there is an emergency supply in place, while building a longer-term solution for distribution to the sector.We are supportive, in principle, of a multilateral instrument dedicated to the rights of older persons and welcome the work of the UN Open Ended Working Group on Ageing and its focus on substance to help deepen our understanding of the important issues, before we consider what might be the most appropriate solutions.

Social Services: Protective Clothing

Lord Alton of Liverpool: To ask Her Majesty's Government what assessment they made of the report by the Association of Directors of Adult Social Services Ensuring DASS and their partner decision makers have the critical and most up to date information and data on needs and capacity to plan for and make timely and rational decisions about the reprioritisation of services in response to a future flu pandemic and Identifying People who are Vulnerable in a Flu Pandemic Crisis, published in March 2018, which stated that (1) demand for personal protection equipment “could rapidly outstrip supply”, (2) advice on controlling cross infection will be required, and (3) they should “provide support with systems to collate data on suitable volunteers…as this was an area of weakness identified”, in the event of a pandemic; and what steps they took in response to that report.

Lord Bethell: The Government has made no specific assessment of the report by the Association of Directors of Adult Social Service’s (ADASS) report of 2018, but the Department engages and considers views of ADASS as a key partner organisation. Since the start of the pandemic we have worked closely with the adult social care sector and public health experts to provide guidance and support, including on controlling infection.On 2 April we published Admission and Care of Residents in a Care Home during COVID-19, which was updated on 19 June. We set out our plans to support the care sector in using and accessing personal protective equipment (PPE) in Covid-19: Personal Protective Equipment (PPE) Plan on 10 April. On 15 April we published our COVID-19: Our Action Plan for Adult Social Care which included strengthened advice around isolation and introduced testing for all patients prior to discharge from hospital to a care home. Copies are attached. On 15 May, the Government announced a support package for care homes backed by a £600 million Infection Control Fund for care homes to tackle the spread of COVID-19.To support the health and social care sectors to respond to the COVID-19 pandemic, we have launched the National Health Service Volunteer Responders programme, developed by NHS England in partnership with the Royal Voluntary Service. It is up to individual social care providers to decide whether to use volunteers. We do not collect data nationally on how many volunteers are operating in the social care sector.Admission and Care of Residents in a Care Home (pdf, 314.0KB)COVID-19 PPE Plan (pdf, 1280.9KB)COVID-19 Action Plan for Social Care (pdf, 284.7KB)

Continuing Care: Coronavirus

Baroness Gale: To ask Her Majesty's Government whether clinical commissioning groups shouldfollow (1) the National framework for NHS continuing healthcare and NHS-funded nursing careguidance, or (2) the Coronavirus (COVID-19): hospital discharge service requirements guidance, when assessing people with a new or enhanced care and support package; and if the latter, whether funding will last for the duration of the COVID-19 emergency period.

Lord Bethell: During the COVID-19 emergency period, National Health Service Continuing Healthcare (CHC) and Funded Nursing Care (FNC) assessments have not been required due to changes made under section 14 of the Coronavirus Act 2020.The COVID-19 Hospital Discharge Service Requirements were published on 17 March 2020 to support the safe and timely discharge of patients who no longer need acute care. A copy is attached.We made £1.3 billion funding available via the National Health Service to support the discharge process. On 17 July 2020, as part of the £3 billion new funding announced for winter, extra funding was confirmed to continue enhanced discharge arrangements over winter.As set out in the on the third phase of NHS response to COVID-19, from Sir Simon Stevens and Amanda Pritchard, published online by NHS England on 31 July 2020, NHS CHC assessments will resume from 1 September 2020. The COVID-19 discharge service requirements will continue to apply until 31 August 2020.Where CHC assessments have continued during the emergency period, these must be compliant with the NHS Commissioning Board and Clinical Commissioning Groups Regulations 2012 and the National Framework for CHC and FNC 2018 (Revised).COVID-19 Hospital Discharge Service Requirements (pdf, 919.9KB)

NHS: Diversity

Lord Taylor of Warwick: To ask Her Majesty's Government what steps they are taking to improve the diversity of NHS senior management.

Lord Bethell: The Department recognises more work needs to be done to encourage and improve diversity in the National Health Service. The NHS People Plan publication of 30 July committed to measures which will contribute to improving diversity of NHS senior management. These include every NHS trust, foundation trust and clinical commissioning group publishing their progress against the Model Employer Strategy goals to ensure that at every level, the workforce is representative of their overall black, Asian and minority ethnic (BAME) workforce. Work continues on the Workforce Race Equality Standard and the Workforce Disability Equality Standard which have led to progress across a number of areas - for example increases in proportion of BAME very senior managers – and shone a light on the difficulties that colleagues with disabilities and long-term health conditions face.

Abortion: Drugs

Baroness Stroud: To ask Her Majesty's Government, further to the remarks by Lord Bethell on 15 July (HL Deb, col 2028) that they intend to keep measures, and regulations introduced during the COVID-19 pandemic under constant review, what plans they have to review the (1) physical, and (2) psychological, impact of the temporary introduction of at-home use of early medical abortion pills.

Lord Bethell: The Department is carefully monitoring the impact of and compliance with the temporary approval of home administration of both sets of abortion medication during the COVID-19 pandemic. Officials have regular meetings with the Royal College of Obstetricians and Gynaecologists, the Care Quality Commission and abortion service providers. The Government has committed to undertake a public consultation on making permanent the COVID-19 measure allowing for home use of both pills for early medical abortion up to 10 weeks gestation for all eligible women. The current COVID-19 measure will be kept in place until the public consultation concludes and a decision has been made. Work to develop the consultation will begin soon and further details will be available in due course.